Yao and Artusio's Anesthesiology: Problem-Oriented Patient Management, 6th ed. Yao S-F, Malthora V, Fontes ML, eds. Philadelphia: Lippincott Williams & Wilkins, 2007. ISBN-10: 0781765102; ISBN-13: 978-0781765107. 1376 pages, $99.00.
Yao and Artusio's Anesthesiology: Problem-Oriented Patient Management was first published in 1983 and now appears in its most recent edition as one of the longer lasting runs of currently published anesthesiology textbooks. From the first edition, Yao and Artusio has been often recommended as a useful, if not critical, aid to the applicant preparing for that very important oral board examination.
The current edition retains the very popular case-based format with the goal of including recent advances in anesthetic practice and surgical procedures. Many chapters have been updated and chapters on perioperative pain management, acupuncture, and electroconvulsive therapy have been added. Authors from several institutions have been included in an effort to reflect a wide scope of anesthetic practice and expertise. The goals of the new edition are to retain the style that has made previous editions immensely popular and to incorporate new issues and viewpoints relevant to contemporary practice.
The book is separated by organ system into 11 sections, each containing several chapters, for a total of 62 chapters. Each chapter begins with a clinical scenario followed by a set of questions related to medical disease and differential diagnosis, preoperative evaluation and preparation, intraoperative management, and postoperative management. The questions are separated from their explanations, giving the reader an opportunity to consider a response before reading further. Each explanation is followed by a set of references, including textbooks, ASA refresher courses, and scientific papers.
The style and depth of information presented make this book a readable and worthwhile pursuit. The problem-oriented style, with situations similar to those faced in daily practice and questions similar to those encountered during oral board examinations, lends relevance to the content. The questions are concise, but provide enough detail to orient the reader to the clinical situation. The explanations focus on clinical application of scientific principle, often incorporating pertinent equations, graphs, or drawings. The explanations do not have the level of detail necessary to function as a primary text for the new learner, but are very accessible to a resident with a sound knowledge base.
The reader will certainly recognize that in many cases, the strategy presented is one of several possible approaches to a clinical problem. While the explanations may or may not agree with one's training or experience, they do meet the editor's goal of providing a “logical” approach to complex issues. Including the viewpoints of authors from several institutions, as well clearly stating that certain practices are standards of specific institutions, avoids the dogmatic undertones present in many clinical manuals. The references provided can guide the reader in further research of controversial issues, although the references are of varying utility.
The breadth of topics presented incorporates many of the clinical issues faced by the “generalist,” as well as many topics seen in subspecialty practice. The cardiac and respiratory sections are especially well organized, informative, and of high yield. Indeed, they would be the sections to start with if nearly 1300 pages for a complete read seem daunting. Some chapters are highly specialized and seemingly out of the realm of typical practice, but are worth exploring because of the fundamental concepts that they contain. The liver transplant chapter, for example, describes many of the physiologic derangements and management pitfalls associated with patients with end stage liver disease—certainly worthwhile information for anyone who will encounter this patient population in other management contexts. Similarly, the chapter on DiGeorge syndrome describes bronchopulmonary dyspalasia and other issues associated with prematurity.
The coverage of pediatric anesthesia is less comprehensive and less organized. Certain pediatric topics, such as congenital heart disease and neonatal emergencies, receive ample attention, while other very common and important topics such as post tonsillectomy hemorrhage are not discussed. The organization of pediatric topics is also an issue. Instead of including pediatric chapters in a separate section, the chapters are distributed at the end of organ system sections. This scheme fits the overall organization of the book, but a complete section covering only pediatric anesthesia would provide more continuity. Given both the popularity of this textbook and the variety of clinical issues related to the pediatric patients, it may well be time for a stand-alone pediatric volume. There are also a few surprising omissions outside of the pediatric topics. For example, two chapters on aortic aneurysm repair cover operative treatment, but there is not a chapter regarding management with endovascular stenting.
This book will deservedly continue to be recommended to young colleagues as a standard for preparation for oral examination. In the reviewers’ estimation, the book deserves a place on the practicing anesthesiologist's bookshelf for clinical reference. But a book that was innovative and unique in its inception 25 years ago is showing a bit of its age for a variety of reasons; not all sections have matured equally. In addition, most texts now include some companion electronic media and/or Internet resources to complement or update the written page. (Notably, the 5th edition can be purchased in electronic format for PDA use.) By staying true to its original format, this classic has aged well but has perhaps inevitably also lost the leading-edge uniqueness of its debut edition a quarter of a century ago.